Special Tests - Upper Extremity

Question 1

Apprehension tests

Answer 1

Anterior shoulder dislocation: Pt in supine with shoulder in 90 deg abd and elbow in 90 deg flexion. Therapist laterally rotates shoulder for anterior dislocation and medially rotates for posterior dislocation. Positive if look of apprehension or grimace prior to reaching end point

Question 2

Sulcus sign

Answer 2

Dislocation or instability. Can be graded by amount of vertical depression. <1cm is 1+, 1-2 cm is 2+, and >2cm is 3+.

Question 3

Ludington’s test

Answer 3

Pt clasps both hands behind head with fingers interlocked. Pt contracts and relaxes biceps. Positive if no movement in biceps tendon and may indicate rupture of long head of biceps.

Question 4

Speed’s test

Answer 4

PT palpates bicipital groove and resists shoulder flexion at forearm with supination. Positive test with pain or tenderness in bicipital groove and may indicate bicipital tendonitis.

Question 5

Yergason’s test

Answer 5

PT places hand on bicipital groove. Pt performs supination against resistance. Positive test indicated by pain or tenderness in the bicipital groove and may indicate bicipital tendonitis.

Question 6

Drop arm test

Answer 6

Arm in 90 degrees of abduction. Pt slowly lowers arm to side. Positive test is indicated by the patient failing to slowly lower the arm to side or by severe pain and may indicate tear of rotator cuff.

Question 7

Hawkins-Kennedy impingement test

Answer 7

Shoulder flexed to 90 degrees and medially rotated. Positive test indicated by pain and may indicate shoulder impingement involving supraspinatus tendon.

Question 8

Infraspinatus test

Answer 8

Elbow flexed to 90 deg and shoulder in 45 deg medial rotation. Pt performs resisted ER. Pain or weakness may indicate infraspinatus strain/tear.

Question 9

Lateral rotation lag sign

Answer 9

With patient’s elbow bent, PT moves shoulder into 20 degrees of scaption and end-range lateral rotation and asks pt to hold position. If pt cannot hold position (shoulder moves into medial rotation), positive for supraspinatus or infraspinatus pathology.

Question 10

Lift off sign (medial rotation lag sign)

Answer 10

Pt has dorsum of hand on low back and is asked to move hand away from back. If unable, PT passively moves hand from back and sees if pt can hold position. Inability to indicates subscapularis lesion.

Question 11

Neer impingement test

Answer 11

Passive shoulder IR and flexion. Grimace or pain may indicate shoulder impingement with supraspinatus tendon involvement.

Question 12

Supine impingement test

Answer 12

Therapist passive moves shoulder into full flexion then laterally rotates and adducts arm. PT then medially rotates shoulder. Positive if there is significant increase in pain with medial rotation.

Question 13

Supraspinatus test

Answer 13

Empty can test. Positive test indicated by weakness or pain and may indicate supraspinatus tendon impingement or suprascapular nerve involvement.

Question 14

Adson maneuver

Answer 14

PT monitors radial pulse and asks pt to rotate head towards test shoulder. Pt extends head while PT laterally rotates and extends shoulder. A positive test indicated by diminished or absent radial pulse and may indicate thoracic outlet syndrome.

Question 15

Allen test

Answer 15

Pt has shoulder in 90 deg abduction, lateral rotation, and elbow flexion. Pt rotates head away from test shoulder while PT monitors radial pulse. A positive test indicated by diminished or absent radial pulse and may indicate thoracic outlet syndrome.

Question 16

Costoclavicular syndrome test

Answer 16

PT monitors radial pulse while pt assumes military posture. Diminished or absent pulse may indicate thoracic outlet syndrome caused by compression of subclavian artery between first rib and clavicle.

Question 17

Roos test

Answer 17

Pt has shoulder in 90 deg abduction, lateral rotation, and elbow flexion. Pt opens and closes hands for 3 minutes. Positive test indicated by inability to maintain test position, weakness of arms, sensory loss or ischemic pain. May indicate thoracic outlet syndrome.

Question 18

Wright test (hyperabduction test)

Answer 18

PT positions pt’s arm overhead in hyperabduction while monitoring radial pulse. Absent or diminished pulse may indicate compression of the costoclavicular space.

Question 19

Acromioclavicular crossover test

Answer 19

Pt or PT moves shoulder into 90 deg flexion and full horizontal adduction. Positive for AC joint injury if pain over AC joint.

Question 20

Active compression test (O’Brien’s test)

Answer 20

Shoulder flexed to 90 deg and horizontally adducted 10-15 deg and medially rotated so thumb points down. Pt resists downward force on arm. Test is repeated with shoulder in lateral rotation. Positive for superior labral tear if more pain with medial rotation than lateral rotation.

Question 21

Glenoid labrum tear test

Answer 21

Pt in supine. PT places one hand on posterior aspect of humeral head while other stabilizes humerus proximal to elbow. PT passively abducts and laterally rotates then applies anteriorly directed force to humerus. Positive test if clunk or grinding sound and may indicate glenoid labrum tear.

Question 22

Jerk test

Answer 22

Pt shoulder abducted to 90 with medial rotation and elbow bent. PT provides axial compression through elbow and horizontally adducts shoulder. A sudden clunk or jerk as the humerus subluxes posteriorly indicates posterior instability. Complaint of pain may indicate presence of a posterior labral lesion.

Question 23

Valgus stress test

Answer 23

Elbow in 20-30 deg flexion. Provides valgus force while palpating medial joint line. Positive test indicated by increased laxity of the MCL, apprehension, or pain. May indicate MCL sprain.

Question 24

Varus stress test

Answer 24

Elbow in 20-30 deg flexion. Provides varus force while palpating lateral joint line. Positive test indicated by increased laxity of the LCL, apprehension, or pain. May indicate LCL sprain.

Question 25

Cozen’s test

Answer 25

Pt asked to make a fist, pronate, radially deviate, and extend wrist against resistance. Pain in lateral epicondyle region or muscle weakness may indicate lateral epicondylitis.

Question 26

Lateral epicondylitis test

Answer 26

Pt extends 3rd digit against resistance. Positive if pain in lateral epicondylitis region or muscle weakness may indicate lateral epicondylitis.

Question 27

Mill’s test

Answer 27

Pronate pt’s forearm, flexes wrist, and extends the elbow. Pain in lateral epicondyle region may indicate lateral epicondylitis.

Question 28

Medial epicondylitis test

Answer 28

Supinates pt’s forearm, extends wrist, and extends the elbow. Pain in medial epicondyle region may indicate medial epicondylitis.

Question 29

Elbow flexion test

Answer 29

Pt fully flexes both elbows and extends wrists and holds position for 3-5 minutes. Positive for cubital tunnel syndrome if tingling or paresthesia is noted in the ulnar nerve distribution of the forearm and hand.

Question 30

Pinch grip test

Answer 30

Pt asked to pinch tips of thumb and index finger together. If pt can only pinch pads of fingers together, positive for pathology of anterior interosseous nerve.

Question 31

Ulnar collateral ligament instability test of the thumb

Answer 31

PT holds thumb in extension and applies valgus force to MCP joint of thumb. Positive test indicated by excessive valgus movement and may indicate tear of UCL and accessory collateral ligaments. May indicate gamekeeper’s or skier’s thumb.

Question 32

Allen test for vascular insufficiency

Answer 32

Pt opens and closes hand several times then holds closed while PT compresses radial and ulnar aa at wrist. Pt opens hand and PT removes compression. Observes for delayed or absent flushing of the radial or ulnar part of hand and may indicate occlusion of an artery.

Question 33

Bunnel-Littler test

Answer 33

MCP joint held in slight extension and PIP joint moved into flexion by PT. If the PIP joint does not flex, there may be a tight intrinsic muscle or capsular tightness. If the PIP flexes with the MCP joint in slight flexion, there may be muscular tightness without capsular tightness.

Question 34

Tight retinacular ligament test

Answer 34

PIP held in neutral position while PT attempts to flex DIP joint. If unable to flex DIP, there may be retinacular ligament or capsule tightness. If able to flex the DIP with PIP in flexion, then the retinacular ligament may be tight without capsular tightness.

Question 35

Carpal compression test (Median nerve compression test)

Answer 35

PT holds pt’s wrist with both hands and applies pressure over the median nerve int he carpal tunnel for 30 sec. Positive for carpal tunnel syndrome if the pt experiences pain or paresthesia in the median nerve distribution.

Question 36

Froment’s sign

Answer 36

Pt asked to hold a piece of paper between thumb and index finger. PT attempts to pull paper from pt. Positive test indicated by the pt flexing the distal phalanx of the thumb due to adductor pollicis paralysis. If pt hyperextends MCP joint, it is termed Jeanne’s sign. May indicate ulnar nerve compression or paralysis.

Question 37

Phalen’s test

Answer 37

Wrists flexed maximally and held against each other for 60 seconds. Positive test indicated by tingling in the thumb, index finger, middle finger, and lateral half of the ring finger and may indicate carpal tunnel syndrome due to median nerve compression.

Question 38

Finkelstein test

Answer 38

Pt makes a fist with thumb inside the fingers. PT ulnar deviates wrist. Positive test indicated by pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist and may indicate tenosynovitis in the thumb (de Quervain’s disease).

Question 39

Murphy sign

Answer 39

Pt asked to make a fist. Positive test indicated by pt’s 3rd metacarpal remaining level with the 2nd and 4th metacarpals. May indicate dislocated lunate.